Immunotherapy has become one of the most important therapeutic tools for the treatment of warts. At present, immunotherapy for warts is usually limited to recalcitrant lesions that are not responding to conventional therapy. Although there are a lot of immunotherapeutic regimens, a minority seem to be really effective. Moreover, there is a lack of evidence-based data on their effectiveness. Common immunotherapeutic modalities used for the treatment of warts include contact sensitizers, imiquimod, intralesional interferon, and oral drugs such as levamisole, cimetidine, and zinc sulfate. Intralesional antigens such as MMR (measles, mumps, and rubella) vaccine, skin test antigens (mumps, Candida, and Trichophyton), BCG (bacillus Calmette-Guιrin) vaccine, and Candida antigen were reported as successful treatment modalities in various forms of warts. Moreover, intradermal injection of some vaccines such as purified protein derivatives was also reported as a successful regimen for the treatment of genital warts. Among the available options for treatment of warts, none is uniformly effective or viricidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, and thus the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. In this report, the various forms of immunotherapy for warts are discussed and each regimen is evaluated in order to assess the efficacy of each form of treatment.

Introduction
Acne scarring is a common complication of acne, and no appropriate and effective single treatment modality has been developed yet. A new technique of focal application of high strength trichloroacetic acid (TCA) (65-100%) has been suggested.
The aim of the study was to evaluate the efficacy and safety of 50% TCA in three different types of atrophic acne scars using the chemical reconstruction of skin scars technique in three sessions, each at an interval of 1 month.
Materials and methods
Thirty adults with a clinical diagnosis of atrophic acne scars were selected.
Results
Statistically significant difference was found in the total Goodman score between the atrophic acne scars before and after treatment (P < 0.0001), especially between the icepick and boxcar scars before and after treatment (P < 0.05). In addition, statistically significant difference was observed in the percentage of improvement between the three types of atrophic acne scars (P < 0.05). The best improved were the icepick type followed by the boxcar scars and then the rolling scars.
Conclusion
Chemical reconstruction of skin scars technique using 50% TCA is nonsurgical and safe in the treatment of atrophic acne scars, especially the icepick type followed by the boxcar scars, with minimal side effects and a short downtime.

Objective
The aim of this study was to assess the efficacy of autologous platelet-rich plasma (PRP) injection for facial rejuvenation.
Patients and methods
In a 6-month study, 20 female patients were treated with three sessions of injection with PRP every month from October 2011 to March 2012. Patients received 3 ml of PRP, activated with calcium chloride into face and neck skin. The study was evaluated by comparing the preinjection and postinjection photographs using digital camera, by final patient's satisfaction questionnaire, and by physician's impression.
Results
A definitive graduated score was found for each patient by adding the final result of each single parameter. Good results were observed in the skin homogeneity and emotional status of the patient without serious side effects.
Conclusion
PRP had an effective treatment in skin rejuvenation without serious side effects.

Background
Acne is a common skin disorder affecting the pilosebaceous unit, arising commonly during adolescence and causing psychological stress. The pathogenesis of acne is attributed to multiple factors. Clinically, it is characterized by the presence of comedones, inflammatory papules, pustules, and sometimes nodules and cysts. Propolis has been attracting the attention of researchers because of its antimicrobial, antioxidant, antiviral, and antifungal properties.
Objectives
The aim of this study was to evaluate the clinical and bacteriological significance of topical propolis extracts in the treatment of facial acne vulgaris.
Patients and methods
This study included 40 patients with facial acne vulgaris. The patients were classified into two groups: group I included 20 patients who were treated with a topical solution of ethanolic extract of propolis, and group II included 20 patients who were treated with a topical solution of ethanol only and served as the control group. Patients were evaluated clinically to assess the efficacy of therapy after treatment. Bacteriological examination was carried out before and after treatment to assess the antimicrobial effect of propolis.
Results
There was a highly significant clinical efficacy of topical solution of ethanolic extract of propolis in the treatment of acne vulgaris. There was a highly significant bacteriological efficacy of topical solution of ethanolic extract of propolis on gram-positive aerobic (Staphylococcus epidermidis) and gram-positive anaerobic bacteria (Propionibacterium acnes).
Conclusion
Topical propolis is a promising, effective, well-tolerated, safe, and alternative medication for acne vulgaris. It has anti-inflammatory and antibacterial properties. Further studies are needed for its application in different skin diseases.

Background
Vitiligo is an acquired depigmenting disorder. The exact etiopathogenesis of vitiligo is not fully understood. Vitamin B12 and folic acid levels are decreased in vitiligo, which are important cofactors required for the metabolism of homocysteine (Hcy). Consequently, the Hcy level increases in the circulation. Therefore, it is possible that increased Hcy plays a role in the destruction of melanocytes.
Objective
To determine the role of Hcy, vitamin B12, and folic acid in the pathogenesis of vitiligo.
Patients and methods
Thirty-five patients of both sexes with vitiligo and 35 age-matched healthy controls were included in the study. After excluding factors that may affect serum Hcy levels, blood samples from patients and controls were obtained for Hcy, vitamin B12, and folic acid determination by an enzyme immunoassay.
Results
The mean serum level of Hcy was significantly higher in patients with vitiligo than in the controls (17.77 ± 7.72 vs. 11.81 ± 3.41 μmol/l; P < 0.05), whereas the mean level of vitamin B12 was lower in patients with vitiligo than in the controls (208.64 ± 66.73 vs. 304.7 ± 89.9 pg/ml; P < 0.05). There was no statistically significant difference in the folic acid level in patients and controls (8.42 ± 2.06 vs. 9.39 ± 2.38 ng/ml; P > 0.05).
Conclusion
Elevation of serum Hcy level might be a precipitating factor for vitiligo in predisposed individuals. Hcy level may represent a new biomarker of the extent of vitiligo. Elevation in Hcy is associated with relative deficiencies of vitamin B12, suggesting that aggressive supplementation may benefit vitiligo patients.

Background Cutaneous warts are benign papillomas of the skin caused by infection with human papillomavirus. The primary treatment methods of warts are physical destruction. However, these treatments are not suitable for patients with multiple lesions or with fear of pain and scarring. Therefore, immune-modifying agents might be a useful therapeutic alternative because they can be painlessly and easily administrated. Zinc is a trace element that is essential for the functioning of the immune system. It could counteract viral infections. Zinc sulfate is a promising therapy for the management of multiple warts.
Aim The aim of this study was to determine the association of low serum zinc levels with persistent viral warts and to assess whether oral zinc sulfate was effective in treating persistent viral warts.
Patients and methods This randomized case–control clinical trial was conducted on 40 patients. Eligible patients had five or more warts of at least 6-month duration resistant to one or more lines of treatment. Blood samples of all patients were taken to determine basic serum zinc level using spectrophotometry. Patients were randomly divided into two groups; each group consisted of 20 patients. Group I received oral zinc supplementation 10 mg/kg up to 600 mg maximum daily dose for 1 month. Group II did not receive any treatment. All of the patients were instructed not to take any other treatment during the trial. At the end of the study, the patients were assessed and the serum zinc level was remeasured. The percent of improvement of the warts was classified as follows: excellent, greater than 75%; moderate, 75–50%; mild, less than 50%; and no change.
Results At the beginning of the study, the mean serum zinc level in group I was 85.95 μg/dl and that in group II was 81.30 μg/dl. However, at the end of the study, the mean serum zinc level in group I was 115.61±19.69 μg/dl and that in group II was 81.90±36.04 μg/dl. Serum zinc level significantly increased after treatment compared with that before treatment in group I (P=0.013); moreover, it became significantly higher than that in group II (P=0.006). The significant increase in serum zinc level in group I was associated with more clinical improvement in the warts. Shorter duration of the disease was associated with better response. Patients with excellent improvement had significantly higher serum zinc level than those with no improvement.
Conclusion Our findings suggest that oral zinc supplementation should be considered as a therapeutic option in the treatment of recalcitrant multiple warts. Zinc deficiency is relatively common in our population. Oral zinc supplementation was associated with elevation of serum zinc level, which was associated with clinical improvement in the warts.

Background
Semen hyperviscosity (SHV) is a condition that can markedly impair the physical and chemical characteristics of seminal fluid, which leads to an adverse impact on sperm function.
The aim of this study was to assess the prevalence of SHV in infertile Egyptian men and to evaluate its effects on physical and biochemical semen parameters, and also to identify any correlation between SHV and infections or inflammation of the genital tract.
Participants and methods
Semen samples were studied for 300 infertile men; of these, 225 men had normal semen viscosity and were excluded from the study. Seventy-five men with SHV were selected and included in this study. In addition, 25 fertile men with completely normal semen parameters who had recently fathered children were included as a control group. All participants underwent seminal analysis and measurement of seminal plasma fructose, ascorbic acid, calcium, and zinc, in addition to a peroxidase test and polymorphonuclear granulocyte elastase (PMN elastase).
Results
Our study showed that the prevalence of SHV was 25% in infertile Egyptian men. Sperm motility and sperm vitality, in addition to fructose, ascorbic acid, calcium, and zinc levels, were significantly reduced, whereas PMN elastase levels were significantly increased in samples with hyperviscosity (P < 0.05). There was a strong positive correlation between PMN elastase levels and increasing viscosity.
Conclusion
Our results showed that hyperviscosity seems to be the result of infection or inflammation in 75% in our cases and hyperviscosity seems not to be because of a single pathogenic factor, but rather because of several (biochemical, enzymatic, and genetic) factors that act in synergy. These factors should be studied further.

Risks for metabolic syndrome and cardiovascular diseases in both male and female patients with androgenetic alopeciaNaglaa AgamiaJuly-December 2015, 35(2):49-55DOI:10.4103/1110-6530.178459

Background
Androgenetic alopecia (AGA) is a nonscarring progressive miniaturization of the hair follicle with a usually characteristic pattern of distribution in genetically predisposed men and women. Although several previous studies have investigated the association of metabolic syndrome (MS) and cardiovascular risks with AGA, the results have been inconsistent.
Aim
We attempted to evaluate the possible association between MS and cardiovascular risks with AGA in both male and female patients. This may help to detect whether AGA can be considered as a clue for underlying serious systemic diseases.
Patients and methods
A total of 50 patients (38 male and 12 female) and 50 normal sex-matched and age-matched controls were included. Anthropometric measures, blood pressure, fasting glucose, high-density lipoprotein cholesterol, triglycerides, testosterone, sex hormone binding globulin, and serum insulin levels were evaluated. Acute phase reactants (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate) were measured for all participants. The presence of MS, insulin resistance, and cardiovascular risk factors were evaluated.
Results
There were statistically significant differences with regard to the mean values of waist circumference, BMI, systolic blood pressure, fasting blood sugar, fibrinogen, and Homeostasis Model Assessment of Insulin Resistance in both male and female patients. In contrast, triglycerides, cholesterol, MS, erythrocyte sedimentation rate, and sex hormone binding globulin were significantly elevated in male patients only in relation to their sex-matched controls.
Conclusion
Patients of both sexes with AGA are more susceptible to have cardiovascular diseases in future compared with people who do not have AGA.

Photochemotherapy is considered a key tool for dermatologists in treating numerous, diverse conditions. Accordingly, there is a continuous effort to evaluate the well-settled indications, seek new ones for these lines of treatment, singly or in combination, aiming at better results and fewer side effects. The limitations and risks that photochemotherapy bears and the proper management plans are other fields of interest. In this article we will discuss some of the important clinical research studies in the domain of photochemotherapy published during the past year in an attempt to emphasize the up-to-date recommendations, widen our therapeutic scope, and expand our forthcoming research plans as dermatologists and researchers.

Phytic acid (myoinositol hexaphosphate) is found in almost all grains, fibers, and plants. It is a natural plant antioxidant. Easy phytic peel is a commercial product; it has a slow release, which promotes continuous penetration of the skin, and requires no external neutralization.

Aim

The aim of this study was to evaluate the effect of chemical peeling using a solution composed of phytic acid, glycolic acid, lactic acid, and mandelic acid in the treatment of acne vulgaris and melasma.

Methods

This study was carried out on 40 patients: 20 with active lesions of acne vulgaris and 20 with melasma. Both groups were treated with the aforementioned solution every week for 6 weeks.

Results

A highly significant decrease in the Global Acne Grading System scores and the Melasma Area Severity Index scores was reported after treatment (P<0.001) in case of patients with acne and melasma, respectively. However, the results of peeling were much more promising in patients with active acne compared with in those with melasma. No side effects were observed during or after treatment.

Conclusions

Peeling with this combination can be considered an effective, safe, and well-tolerated procedure in the treatment of patients affected with active acne and melasma.

Context
Leprosy is a chronic granulomatous infectious disease process in humans primarily involving the skin, peripheral nerves, and nasal mucosa but capable of affecting any tissue or organ. The leprae bacilli were first observed by Hansen in 1868. Although this was the first bacterial human pathogen to be described, it continues to remain one of the least understood.
Aims
The aim of the study was to evaluate oral and facial manifestations in patients affected with leprosy.
Materials and methods
The present study was performed with an aim of reviewing oral and facial manifestations in patients suffering from leprosy. For this, 150 patients suffering from lepromatous and tuberculoid forms of leprosy were included in the study. The study was approved by the ethical committee appointed by SIBAR Institute of Dental Sciences, Guntur. Permission was also taken from asylum management and the district leprosy officer to conduct the study. All study samples were patients diagnosed with Hansen's disease by a leprologist using a bacteriological index.
Results
In the present study, oral and facial manifestations were observed more frequently in the lepromatous type of leprosy than in the tuberculoid form. Also, these manifestations were less pronounced in group I than in group II and were more in groups III and IV based on increased exposure to the disease process. Statistical analysis was performed using the c2 -test and P values were also found to be significant.
Conclusion
Present day diagnostic protocols for early detection and treatment are effective in controlling the disease and in preventing further progression with severe orofacial manifestations. A dentist should be able to recognize these manifestations and treat them under the supervision of a leprologist. Protective care must be taken in treating the disease, although it should not be held as a nightmare as was considered previously.

Background Vitamin D is a fat-soluble vitamin and synthesized in the skin from 7-dehydroxy cholesterol during exposure to ultraviolet B. Vitamin D is essential for calcium homeostasis, bone growth, and immune regulation. Vitamin D deficiency causes rickets, osteomalacia, osteoporosis, and muscle weakness. Vitamin D deficiency is associated with cancers, cardiovascular diseases, schizophrenia, wheezing illness, and autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, type 1 diabetes mellitus, multiple sclerosis, Crohn’s disease, psoriasis, vitiligo, and chronic urticaria.
Objective The main objective of this study was to analyze the 25-hydroxy vitamin D status of patients with psoriasis in comparison with controls without psoriasis.
Patients and methods This study included 30 patients (age-matched and sex-matched controls) from the Outpatient Department of Narayana Hospital Dermatology Department in Nellore, Andhra Pradesh. All patients and controls were studied during the 4-month period from July 2015 to October 2015.
Results Serum 25-hydroxy vitamin D levels were significantly lower in psoriatic patients than in controls even after adjusting for confounding factors in a multivariate analysis. Low 25-hydroxy vitamin D levels were positively associated with psoriasis and BMI in multiple linear regression analysis. Psoriatic patients with BMI greater than or equal to 27 kg/m2 had a higher risk for 25-hydroxy vitamin D insufficiency.
Limitations Further studies with larger numbers of patients are required to analyze the pathogenic mechanisms underlying the relationship between 25-hydroxy vitamin D deficiency and psoriasis.
Conclusion The 25-hydroxy vitamin D values are significantly lower in psoriatic patients than in controls. Low 25-hydroxy vitamin D levels are positively associated with psoriasis and with obesity.

Prevalence of pediculosis capitis among primary school students at Sharkia Governorate by using dermoscopyManal M El-Sayed, Mohammed A Toama, Ahmed S Abdelshafy, Abdulla M Esawy, Safaa A El-NaggarJuly-December 2017, 37(2):33-42DOI:10.4103/ejdv.ejdv_47_16

Background
Pediculosis capitis is the infestation of human hair and scalp by head lice. Dermoscopy was used to improve the health of students in Sharkia Governorate by decreasing the prevalence of pediculosis capitis among them.
Aim
The aim of the present study was to determine the prevalence of pediculosis capitis among primary school students in Sharkia Governorate, find the risk factors associated with this infestation, and to compare the traditional methods in diagnosis of pediculosis capitis with dermoscopy.
Participants and methods
This study was conducted on 242 students in Sharkia Governorate. Clinical and dermoscopic examinations were carried out for all children.
Results
Dermoscopic examination of the studied children was as follows: 44.6% of them were free of infestation or dandruff, 17.8% were also free of infestation but showed dandruff, which may be misdiagnosed as nits, and 4.1% showed empty nits only. Thus, the total negative was 162 (66.9%). Only 0.4% of them showed empty nits with dandruff. About 7.4% of them were with empty and filled nits, 21.9% were with filled nits only, and 0.4% of them showed mobile lice. Hence, the prevalence of pediculosis capitis was 33.0% by using dermoscopic examination.
Conclusion
Prevalence of pediculosis capitis among primary school students in Sharkia Governorate was 33.0% by using dermoscopic examination. Pediculosis capitis was found to be affected by some sociodemographic characteristics as sex, residence, social class, father’s and mother’s education, and some behaviors as combing of hair and sharing tools; moreover, hair length was shown to increase infestation. Overall, dermoscopy was found to be better in diagnosis pediculosis capitis compared with visual examination.

Background
Neonatal dermatology, by definition, encompasses the spectrum of cutaneous disorders that arise during the first 4 weeks of life. A host of aberrations varying from physiological and transient to grossly pathological are observed in the skin of a neonate.
Objective
The aim of this work was to study the prevalence of dermatoses in neonates and to establish the correlation between various neonatal factors, maternal factors, and the occurrence of dermatoses.
Patients and methods
A total of 200 randomly selected live-born neonates delivered and admitted to the postpartum ward, neonates admitted to the Neonatal Intensive Care Unit, and neonates attending the Dermatology Outpatient Department were included in this study. A detailed assessment of history was performed and a detailed dermatological examination of each of the neonates was carried out. Laboratory procedures were performed as required.
Results
The most prevalent findings were miniature puberty (71%), Mongolian spot (64.5%), lanugo hair (63%), sebaceous gland hyperplasia (62%), erythema toxicum neonatorum (38%), salmon patch (35%), physiological scaling of the newborn (30.5%), milia (27%), miliaria (18.5%), Epstein's pearls (17.5%), and iatrogenic bruises (17.5%).
Conclusion
A thorough knowledge of the skin changes, physiological as well as pathological, in neonates is of prime importance for the dermatologist as well as pediatrician.

Background
Studies suggest that reactive oxygen species (ROS) attack the integrity of DNA in the sperm nucleus by causing base modifications, DNA strand breaks, and chromatin cross-linking. Sperm DNA damage analysis may reveal hidden sperm DNA abnormalities in infertile men with normal standard semen analysis values who were diagnosed with idiopathic infertility.
Aim of the work
We explored the levels of ROS and their correlation with sperm DNA damage in patients with idiopathic male infertility.
Patients and methods
A total of 93 men were included in this study. Among them, 68 presented to our Andrology outpatient clinic with idiopathic infertility and were selected, and 25 were healthy fertile men, who were assigned to the control group. Both groups were subjected to the following laboratory investigations: semen analysis including peroxidase test, measurement of ROS levels by chemiluminescence assay, and sperm DNA damage assessment by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL).
Results
There were no significant differences in the semen parameters between idiopathic infertile men and controls. However, ROS and sperm DNA damage levels were significantly higher in idiopathic infertile men compared with controls ( P ͳ 0.001). In addition, the results showed a strong positive correlation between ROS levels and the percentage of sperm DNA damage ( P ͳ 0.001).
Conclusion
Traditional semen analysis does not reveal seminal defects at the molecular level that might be induced by ROS. Therefore, our results suggest that standard semen analysis should be coupled with measurement of ROS and assessment of DNA integrity in cases of idiopathic male infertility as even sperms with normal morphology and motility may harbor DNA damage.

Background
Female-pattern hair loss (FPHL) is the most common cause of diffuse hair loss in women. A possible role of non-androgen-dependent mechanisms was suggested. The association between serum 25-hydroxyvitamin D [25-(OH)D] and other hair 0 diseases such as male androgenetic alopecia, telogen effluvium, and alopecia areata has been indicated.
Objective
The aim of this study was to evaluate the association of altered serum 25-(OH)D levels in women with FPHL.
Patients and methods
We studied serum 25-(OH)D concentrations among 60 FPHL patients aged from 20 to 35 years in comparison with 60 healthy female controls matched for age, skin phototype, socioeconomic status, and outdoor exposure. Measurements were conducted by the radioimmunoassay technique.
Results
The mean serum 25-(OH)D level was significantly lower in FPHL patients (14.2 ± 7.31 ng/ml) than in controls (45.90 ± 18.83 ng/ml; P = 0.0001). There was no significant difference between patients with family history and those without family history regarding the mean vitamin D level (15.23 ± 7.56 and 13.6 ± 7.17 ng/ml, respectively; P = 0.363). A significant difference was found between the three Ludwig's degrees regarding the mean vitamin D level (12.96 ± 7.52, 14.16 ± 5.68, and 25 ± 5.35 ng/ml, respectively): between degrees I and III and between degrees II and III.
Limitations
This is a case-control study that supports the hypothesis of an association between vitamin D and FPHL, but does not establish a causal relationship.
Conclusion
Alteration in the serum 25-(OH)D level, being deficient or insufficient, might play a possible role in the pathogenesis of FPHL.

Phocomelia is an extremely rare malformation in which babies are born with limbs that appear similar to the flippers of a seal. Although various factors can cause phocomelia, the prominent roots came from the use of thalidomide and from genetic inheritance. Phocomelia is transmitted as an autosomal recessive trait with variable expressivity, and malformation is linked to chromosome 8. Presented here is the incidental detection of phocomelia in a young man with no history of thalidomide intake and for whom evaluation of other family members/siblings failed to reveal any substantial abnormality, making it a probable case of sporadic mutation-induced phocomelia.

Background
A variety of modalities have been used and, depending on the scar type, treatment may be invasive and/or conservative.
Objective
The aim of this study is to assess the safety and efficacy of treating stable nonhypertrophic scars using a fractional carbon dioxide (CO 2 ) laser.
Patients and methods
This is a prospective study of 25 patients (skin types III-IV, aged 6-37 years) with stable nonhypertrophic scars who underwent at least three sessions with a fractional CO 2 laser at 1-month interval. Side effects as well as improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale by the patients and investigators after each treatment and 4 weeks after the final treatment. Before-after scores were compared using the Student t-test, with significance assigned to P values less than 0.05.
Results
All patients showed clinical improvement. There was no significant difference between the assessment of the investigator and the two blinded dermatologists. In terms of patient satisfaction, 32% of patients were not satisfied to slightly satisfied, whereas 68% were satisfied and 20% were very satisfied to extremely satisfied. Side effects were minimal and transient.
Conclusion
Fractional CO 2 laser treatment represents a safe, well-tolerated, effective, and promising treatment modality for nonhypertrophic traumatic and postinflammatory scars, with minimal downtime and fewer side effects.

Background
Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis (HD), which prolongs life expectancy, providing time for these changes to manifest.
Objective
The aim of this study was to estimate the prevalence and pattern of cutaneous manifestations among patients with CRF on regular HD.
Patients and methods
This case-series study included 100 patients with CRF on regular HD. They were subjected to a full assessment of history, and general and dermatological examinations of the skin, hair, nails, and oral mucosa.
Results
All patients included in this study had at least one cutaneous manifestation attributed to CRF. The most prevalent finding was xerosis (72%), followed by pruritus (52%) and hyperpigmentation (44%), whereas purpura (2%) and bullous dermatosis (1%) were the least detected. Oral changes included xerostomia (46%), macroglossia with teeth markings (43%), fissured tongue (17%), ulcerative stomatitis (11%), and angular cheilitis (6%). The most common nail changes were absent lunula (61%), half and half nail (41%), and koilonychia (29%). Hair changes included sparse scalp hair (48%), sparse body hair (41%), and brittle and lusterless hair (39%). Hypertension and diabetes mellitus were the most common causes of CRF (53 and 18%, respectively).
Conclusion
Every CRF patient on HD had at least one cutaneous manifestation, which may appear before or after HD. The most common cutaneous manifestations were xerosis, pruritus, hyperpigmentation, xerostomia, macroglossia, absent lunula, half and half nail, sparse scalp hair, and sparse body hair.

Background
Psoriasis is a genetically determined inflammatory and proliferative disease of the skin. There is now increased evidence for the role of nitric oxide in some diseases, including psoriasis. Nitric oxide is a potent regulator of keratinocyte growth and differentiation and stimulates angiogenesis.
Aim
This study aimed to detect serum nitric oxide level in active psoriasis patients, to correlate these levels with severity of the disease scored with psoriasis area and severity index, and compare them with those in normal individuals.
Patients and methods
Twenty-five patients with active psoriasis and 25 age-matched and sex-matched controls were recruited after their written consent was obtained. Patients on local or systemic treatment or with coexisting inflammatory skin disease were excluded. Serum nitric oxide levels were assessed using the Griess method.
Results
The mean serum nitric oxide levels (95.96 ± 12.7 μmol/l) were significantly higher in active psoriasis patients than that in the healthy controls (27.1 ± 6.85 μmol/l).
Conclusion
The significantly elevated serum levels of nitric oxide and their positive correlation with the severity of psoriasis may suggest the possible role of this mediator in the etiopathogenesis of the disease, and suggest a potential future therapy for the disease.

Keloid is one of the most challenging clinical problems encountered in wound healing. Although there are numerous treatment modalities, none of them have shown excellent therapeutic results.

Aim

The aim of the study was to evaluate the efficacies of 80% trichloroacetic acid (TCA) and botulinum toxin type A in the treatment of patients with keloid scars.

Methods

Thirty keloid patients were divided into two groups (each consisting of 15 patients). In group A, keloid scars were punctured using a punch instrument previously dipped in 80% TCA, whereas in group B keloid scars were injected intralesionally with botulinum toxin type A (2.5 U/cm3;). All patients underwent three to five therapeutic sessions 1 month apart, and follow-up for 1 year. The therapeutic response was determined according to the scores on the Vancouver scar scale and a self-assessment scale for pain and pruritus.

Results

In group A, the mean scores on the Vancouver scar scale before and after treatment were 9.73±1.33 and 4.94±2.44, respectively, with a total improvement of 49%. In group B, the mean scores on the Vancouver scar scale before and after treatment were 9.05±1.34 and 4.68±2.67, respectively, with a total improvement of 48%. Comparison between mean values obtained on the Vancouver scar scale in groups A and B after treatment showed a statistically nonsignificant difference. Group B showed better improvement as per the self-assessment score. Most common side effects were reported in group A and were in the form of hyperpigmentation (33.3%), hypopigmentation (6.7%), and mixed pigmentation (6.7%). Relapses occurred in 26.7% of patients in group A, whereas no relapses occurred in group B.

Conclusions

The 80% TCA multiple puncture technique is better than botulinum toxin type A in the treatment against keloids.

Background
Acne vulgaris is a multifactorial disease, but recent studies have focused on the role of oxygen free radicals and antioxidant enzymes. Malondialdehyde (MDA) is the end product of lipid peroxidation and is a good marker of free radical-mediated damage and oxidative stress. Superoxide dismutase (SOD) represents the major cellular defense against superoxide anions.
Objective
The objective of this study was to study the role of oxidative stress in acne vulgaris and to detect a possible link with the different clinical severities.
Patients and methods
Fifty patients with acne vulgaris and 20 healthy controls were included in this study. The severity of the disease was assessed using the Global Acne Grading System. The levels of SOD in erythrocytes and MDA in plasma were measured using a spectrophotometer.
Results
Although higher SOD levels and mean values were present in patients, there was no statistically significant difference compared with the controls. MDA levels showed a significant difference between patients and controls (P < 0.05), with MDA being higher in patients, indicating a condition of oxidative stress that had resulted from a high level of lipid peroxidation in acne patients. Comparison of SOD levels in patients showed that patients with severe acne had the lowest levels in comparison with patients with mild and moderate acne (P < 0.001). SOD levels were the highest in patients with mild acne. In terms of MDA levels, patients with severe acne showed the highest plasma MDA levels compared with those with mild and moderate (P < 0.05) acne, suggesting an increase in reactive oxygen species production overwhelming the antioxidant capacity. The lowest MDA levels were observed in mild acne.
Conclusion
Oxidative stress may play a role in the etiopathogenesis of acne and⁄or the progression of the disease. Coadministration of antioxidant drugs with various lines of treatment of acne might be helpful, especially for those with inflammatory lesions.

Background
Cryotherapy (Cryo) and topical 5-fluorouracil (5FU) are both considered as successful noninvasive therapeutic options for basal cell carcinoma (BCC).
Objective
The aim of the study was to investigate the efficacy of combined Cryo and topical 5FU (Cryo+5FU) in patients suffering from BCC.
Design
This was a prospective clinical trial with a 6-month follow-up.
Duration
The study was carried out during a period of 11 months from March 2012 to February 2013.
Patients and methods
Fifteen patients complaining of BCC were included.
Intervention
Intervention included combined weekly regimen of Cryo followed after 3 days by twice daily 5FU application for four successive days for a maximum of 6 weeks.
Main outcome measures
Assessments of clinical improvement by examination, dermatological photography, and skin biopsy were the main outcome.
Results
All 15 patients achieved complete response with minimal side effects, good cosmetic outcome, and relatively shorter duration of treatment.
Conclusion
Combined Cryo+5FU offers a new effective modality for treatment of BCC.

Background and objectives
The relationship between androgenetic alopecia (AGA) and cardiovascular diseases has been studied by some authors in the past, although the results of epidemiological studies have been variable. The objective of this study was to determine the prevalence of hypertension and aldosterone level in male patients with AGA.
Patients and methods
Sixty men were enrolled in this case-control study, 30 with a diagnosis of AGA and 30 control participants who consulted for other skin conditions. They were recruited from the outpatient clinic of the Dermatology and Andrology of Benha University Hospital. Data were collected included, age, AGA score with Ebling score (I-V), serum aldosterone and serum testosterone level, blood pressure or history of hypertension, smoking, family history of AGA, and treatment.
Results
Patients with AGA showed significantly higher aldosterone levels and blood pressure values (P < 0.05) versus controls. However, there was no statistically significant difference between patients and controls in the serum testosterone level.
Conclusion
Blood pressure screening of patients with AGA will enable earlier diagnosis of an unknown hypertension and initiation of appropriate treatment. Moreover, determination of aldosterone levels can enable early detection of individuals at risk and initiation of preventive treatment before cardiovascular disease becomes established.